Available online http://ccforum.com/content/8/1/57 We would like to thank MacDuff and Grant [1], as well as the many others who accessed it, for their interest in our article [2] on usin
Trang 1Available online http://ccforum.com/content/8/1/57
We would like to thank MacDuff and Grant [1], as well as the
many others who accessed it, for their interest in our article
[2] on using central venous catheters for pleural drainage
We started using this technique about 5 years ago with the
aim of achieving better patient comfort without compromising
on adequate pleural drainage We did not at that time have
access to the specific chest drainage systems mentioned by
MacDuff and Grant While we agree that the central venous
catheters we describe are not specifically designed for the
purpose of pleural drainage, they are made of biologically
inert materials with a long track record of intravenous use
We have not modified them before placement To minimize
the risk of complications at insertion, we were selective in our
choice of patients and we monitor these patients closely from
the safety and efficacy points of view
We share MacDuff and Grant’s views on the need to
practice safely in the current medico-legal climate Our
management is frequently influenced by the need to be seen
to be medico-legally correct This, however, has probably
resulted in the increased per-patient care cost We find this
to be especially true in the use of specially designed
equipment whose usage levels are fairly low In the case of
the two catheter systems mentioned by MacDuff and Grant,
the prices quoted in Singapore are between eight and
10 times higher than the cost of the single lumen central lines
described
We intuitively agree that these catheters with the multiple
drainage lumens have a lower risk of catheter blockage
compared with the central venous catheters We are not,
however, aware of any published literature that ascertains
this We have not experienced any catheter blockage with
the catheters we use despite seeing fibrinous material in the
drainage bag
We have been caught by surprise at the number of readers who accessed this article, perhaps because this is an Open Access article A number of these readers may work in financially stretched healthcare systems We hope that by sharing our experience this technique may prove useful when
it is difficult to procure specially designed sets, either because they are expensive or because they are not readily available We caution readers, however, to select their patients carefully and to monitor the efficacy of the placement of these catheters We do not advocate using this technique for the drainage of haemothoraces or empyemas
References
1 MacDuff A, Grant IS: Should central venous catheters be used
to drain pleural effusions? Crit Care 2004, 8:56.
2 Singh K, Shi L, Bellomo R: Pleural drainage using central
venous catheters Crit Care 2003, 7:R191-R194.
Letter
Should central venous catheters be used to drain pleural
effusions? Authors’ response
Kulgit Singh1, Shi Loo2 and Rinaldo Bellomo3
1Consultant, Department of Anaesthesiology, Tan Tock Seng Hospital, Singapore
2Senior Consultant, Department of Anaesthesiology, Tan Tock Seng Hospital, Singapore
3Professor of Medicine, University of Melbourne, Director of Intensive Care Research, Department of Intensive Care, Austin & Repatriation Medical
Centre, Heidelberg, Melbourne, Victoria, Australia
Correspondence: Kulgit Singh, Kulgit_singh@ttsh.com.sg
Published online: 2 January 2004 Critical Care 2004, 8:57 (DOI 10.1186/cc2448)
This article is online at http://ccforum.com/content/8/1/57
© 2004 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X)